A Clinical Study of Perforative Peritonitis

Santhosh Kumar, S (2016) A Clinical Study of Perforative Peritonitis. Masters thesis, Thanjavur Medical College, Thanjavur.


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Peritonitis is the inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Peritonitis is often secondary to an infection into the otherwise sterile peritoneal environment through perforation of gastrointestinal tract or a chemically irritating material, such as gastric acid from a perforated ulcer. Frequent causes of secondary bacterial peritonitis include perforation due to peptic ulcer disease, acute appendicitis , ileal perforation due to typhoid & tuberculosis, jejunal perforation most often due to blunt trauma, colonic perforations secondary to closed loop obstruction or malignancy. The objectives of this study is to analyse the age / sex incidence ,estimate the relative frequency of anatomical site, the mode of presentation, usefulness of investigative procedures in diagnosis and outcome of surgical management for perforative peritonitis. This study has been based on the analysis of 75 cases of hollow viscous perforation admitted to Thanjavur medical college hospital. Exclusion criteria were peritonitis secondary to post operative anastomotic leak, Chronic obstructive pulmonary disease patients, patient undergone any previous abdominal surgeries, trauma, any chronic illness. The diagnosis and examination was made with history, clinical features and X-ray abdomen erect posture or CT abdomen to support the diagnosis and intraoperative findings. The highest number of patients encountered in this series were in the age group 50 years and above followed by the age group of 40 -49 years. The ratio of men to women with all types of perforation irrespective of site and pathological condition was 9:1. The commonest site involved in this study was duodenal ulcer perforation (62.67%) followed by appendicular perforation (9%) and gastric perforation (7%). In case of peptic ulcer perforations, pain abdomen and vomiting, Fever were the predominant symptoms. Tenderness, guarding rigidity, obliteration of the liver dullness were the predominant signs. In the present study, pain abdomen was present in all cases. Vomiting was present in 56 0ut of 75 patients. Fever was present in 44 out of 75 patients. Guarding and rigidity was present in 47 out of 75 patients. Bowel sounds were absent in 84 % of patients at the time of presentation. Absence of liver dullness was present in all cases of Gastric, ileal and jejunal perforation. In 47 patients of duodenal ulcer perforation, liver dullness was obliterated in 36 patients of duodenal ulcer perforation. Liver dullness obliteration was absent in all cases of appendicular perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum in radiograph. Free gas under diaphragm was present in 32 cases of duodenal ulcer perforation (68%), all cases of ileal perforation, jejunal perforation. one case of ascending colon and rectal perforation showed minimal free air in radiograph. Computed tomography was done in 28 of 75 patients with clinical suspicion of peritonitis, with no free air in X Ray chest & abdomen erect. Computed tomography aided in diagnosis in all (100%) cases with no free air in x rays. Laparotomy with closure of the perforation with omental patch (72%) is the commonest operative management for perforated peptic ulcer. Wound infection 26 % was the most common post operative complication followed by lower respiratory tract infection 15% and upper respiratory infection in 10 %. The mortality rate observed in this study were 12.7%, 14.2%, 50% Duodenal , gastric and ileal perforation respectively. The overall mortality rate is 12%.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Perforative Peritonitis ; Clinical study.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 20 Dec 2017 13:44
Last Modified: 20 Dec 2017 13:44
URI: http://repository-tnmgrmu.ac.in/id/eprint/4597

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